Growing pains

It appears, Kevin, judging by your post to rdp1210 on the other thread, that you were having a bad morning. I hope your afternoon is better. Tell you what...I'll leave you alone for awhile, (I have so much more ammunition that you've provided me), provided that you tell RobertIsaacs why you liked my article in PMM. Further, maybe you can tell all of us why your website lumps RLS and GP's together...are they the same in your mind? Are they the result of overuse syndrome? I'm sure Isaacs would like to know, after all you're one of his mentors. And finally...maybe you can inform Robert who Dr. Valmassy is, and the achievements he's made in his career.

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Hope and Change is now Twist and Scream.

 

Always happy to admit that I was wrong. Can I get another try?

 

Stage 2, revisited...Bored now.

 

I'm still having LOTS of fun Neville Chamberlain? Seriously? You really are hilariously scraping the barrel.

Um, no, it was because you asked me to? Like, 4 times? Sorry, were there more there than you wanted people to be reminded of? I grant that it does somewhat give lie to the "I'm the only one to come up with a theory" thing that you've got going on, but really, you kinda pushed for it.

Nope. But the day they rock up in here claiming to be the ONLY one to solve the great riddle, and that they have the definitive answer, based on an attempt at a research paper that would not pass at undergraduate level, you may be sure that I will. :drinks

Wait... were you... yes I do declare, you appear to be attempting to dismiss other peoples studies! Hitting perfectly onto stage 4

And its in the net!!!

Which means it remains only for me to state that:-

And we're home free. Thanks for playing DrHunt. I'd been a little concerned that letting you know how predictable your line of argument was might inspire you to come up with something left field, but god bless you, you stayed the course like a trooper, to the bitter end. Proud of you our kid. :drinks

Because I'm having far, far too much fun. And I rather think I'm not the only one.

Night now gents and ladies. Hope you've all had fun.

 

Yaaaawn....Spooner stated on another thread that you "completely battered" me here. What a crock. What you've succeeded in doing, is posting blather...none of the post links support your original contention that there were 4 other theories why orthotics work. Not one. However, in my pilot study, I presented a manner by which my theory can be tested. You've ignored that, instead attempting to mock a pain response from the patient, (guarded reaction), because I didn't offer any scale. You've also conveniently ignored the fact that two of the subjects' pain returned when treatment was removed, only to successfully respond again when treatment was resumed. How convenient your selective interpretations and reading skills, (or lack thereof), appear to be. In this sense...you're certainly like the Neville Chamberlain of British Podiatry. When facts lead to an obvious conclusion...when all dots become easier to connect...when all the writers ask is that the hypothesis is tested in the offices worldwide, and ask for nothing else...you've earned that comparison because it fits. Oh...and I thought the "Clark" comparison was rather ingenious...wasn't it? LOL!

Better hurry...there's now 300K hits on Google Scholar!

http://scholar.google.com/scholar?hl=en&q=growing pains in children&btnG=&as_sdt=1,5&as_sdtp=

 

I can see why you need to believe that. But you are, simply, wrong. It is abundantly evident that there are lots of available explanations for GP, and why orthoses might work. Can't really gild the lily more than that without this conversation degenerating into an "oh no they don't, oh yes they do type pantomime. They are there for all to see.

The thing is, whilst I know that YOU will not accept that, the fact is I'm not posting for your benefit, but for the benefit of everyone else following this thread. The danger was that people who are not familiar with the existing research might take you at your word when you say you're the only one to postulate on this. Hence, anyone following this thread can now see for themselves the research which has been done on this, both of high quality and low quality.

So if your aim, in publishing your research and discussing it here, was to satisfy yourself of your own hypothesis, well done! You've convinced yourself. :drinks Bet It was a hard sell.

If your aim is to convince professionals in other fields, who are not familiar with podiatric research, then I'm sure you'll manage it. If someone told me they had made a breakthrough in dentistry or spinal surgery I might be fooled too, since I am largely unaware of other research in those areas. Hell, people have been convinced, not to say duped, in the past, that orthotics cure autism, mestural cramps and asthma. Some people will fall for anything.

If, however, you came on here in the hope that posts would encourage members of your own profession, the experts on matters podiatric, to be impressed by research, or even take it seriously... Yeah, not so much I think.

How do you reckon that's going Dr S? Whilst I hesitate to speak for other people I see nobody besides you supporting your position. :boohoo:

Is there anyone else reading along who still feels that this paper is the ONLY one published which hypothesizes an aetiology for GP?

 

Genuine curiosity Dr S. Feel free to ignore the question if its awkward, but I would like to know.

Brian rothbart, an american trained DPM, now living in Italy, believes, and has represented to the profession for some years, that his very special insoles cure infertility (among other things).

He published case studies, which he called "evidence" for this, and was pretty well eviscerated by most of his peers.

When you read something like that, someone who is solidly convinced of their theory, tests its by trying it out on patients, with no scientific rigor or process to guarantee a fair test, because really, who has time for that, and reports that the success in his small group proves his theory...

Do you believe them? Do you believe that Brians insoles cure infertility? Or do you think that the evidence he proposed was too weak to prove his contention?

Oh by the way, he cures growing pains too.

 

One last chance, Isaacs. Give me ONE link to an article that offers an explanation as to why orthotics work in re to treating GP's, and we'll start there. You stated earlier in this thread that there were four others, and mine made it five. So far, you have yet to provide one. I mean...it's only "proper" to offer those recitations to support your contentions...right? You best get busy....300K and counting.

 

The articles have been given.

The fact that you do not agree with the explanations or hypotheses matters not a jot.

 

Ditto.

 

Nope...not one article discussed the possible efficacy of orthotics in treating GP's. Many, if not all of the articles offered possible explanations for the cause, but if one is astute in F/U research reading, realize that they have been pretty much shot down, much like the theory that rheumatic fever was the culprit back in the 1930's. While many of the researchers have moved away from the theory that is still being peddled to parents and patients, ie., that the long bones are growing faster than the soft tissue, (periosteum?), can "keep up with", this ridiculous explanation is still being forwarded. Psychological explanations actually began prior to the articles listed by Isaacs, but once I exposed that fact, he sloughed off his faux pas in one sentence. He also listed vascular studies, but obviously failed to read Hashkes' article where they determined perfusion rates did NOT have an effect.

But most glaring, is Isaac's continual and quite obvious avoidance of Hashkes' incessant contention that GP's are non-articular, without ever addressing why in any of his offerings. Perhaps you would be so kind as to offering your explanation on this matter...or is that not the reason you're offering posts here?

 

Wow - it has only just dawned on me...sorry, I was being really stupid.

So are you saying that your article is bringing to the table a new explanation as to why growing pains occur?

Or is it saying that foot orthoses are effective in reducing the "subluxation" of the STJ?

Or is it saying that palpation of the sinus tarsi that is painful means that the STJ is subluxed?

Or is it saying that pain in the sinus tarsi will mean that someone will have growing pains?

Or is it saying that foot orthoses are effective in treating growing pains?

Or is saying that growing pains can only be caused by the mechanism by which you are suggesting?

 

While we all should know that orthotics are best suited to control frontal plane motion, my hypothesis is that growing pains are a result of referred pain from the STJ. I offered a method by which this can be tested by the practitioner, several "foot types" that can result in these maladies and viable treatment regimins that I employed in successfully treating it. Is it the only method/manner of doing so? Hardly. And the "cherry on top" is the anatomic/neurologic connection between GP's in children and RLS in adults. I have yet to read that explanation before...anywhere.

Now...can you provide me with a link to any article that explains why/how orthotics work in treating GP's? Isaacs has failed to provide that, and you seem to think otherwise. It would be of such significance for this discussion....don't you think?

 

Robert has listed several articles that hypothesise as to the origin of growing pains.

The question you seem hell bent on getting an answer to is whether or not Robert can provide an article that explain how/why orthotics are effective in treating growing pains.

If what you are suggesting is that there are none, then I'm afraid that you would have to include your own article in that

You have a hypothesis. You prove or disprove the hypothesis. Unfortunately, your article does not do this. The fact that you seem to think your article does prove the hypothesis then also hypothesises and proves that orthotics are effective in treating growing pains says a lot about where you are coming from

 

Thanks for the offer, but I will respectfully decline because I find your style of debating somewhat ill-founded. I actually did read your opinion piece, which as Kevin stated, had the potential to "stimulate some interesting debate"....my interest has since waned.

 

Au contraire. What Robert stated, was that there were 4 other articles that described how ORTHOTICS work to treat GP's, and mine made five. When pushed, he did not list ANY of those articles, (perhaps because they don't exist?), but went on to list numerous articles that anyone with any semblance of data search capabilities could've accomplished. He, and you, have failed to provide me with one article that, in your words, I'm hell bent to read. Let me save you the time in searching...those articles don't exist. That is precisely why Robert continues to duck the issue...he made a statement that he can't back up. Good thing my article doesn't employ that same strategy.

 

I understand your reticence. It does not involve dermatologic pathology and if one is not treating children, then they have no exposure to test my hypothesis. Ill-founded debate style? Please explain.

 

Oh I treat children alright, Matthew. But why should I test your hypothesis? Are you familiar with the concept of burden of proof?

Dictionary definition; Ill-founded = based on weak evidence, illogical reasoning, or the like: an ill-founded theory.

 

Why should you test my hypothesis? Because: 1) you might actually discover the answer as I did over 10 years ago, and in doing so, 2) actually HELP patients, (OMG...have we forgot about our unifying purpose?), and 3) either prove me right or wrong by performing a VERY simple test.

Helping patients...such a novel concept. Hope this helps.

 

Nope. The burden of proof is upon you to test your hypothesis. Not anyone else. End of.

 

Interesting to read that helping patients is not your main goal, and is always superseded by the process by which useful information is forwarded. It makes any further discussions with you easier for me to assess as to your credibility and intent. Although I should've acknowledged that when you and I discussed PsA and it's presentation on another thread, (and the pm's I received from some of your colleagues). Hope this helps.

 

Playing chess with the chicken Bel?

 

I can't speak for Robert. But here is my view

I don't know if there are any articles that

However, I am absolutely certain that your article does not prove how/why orthotics work to treat GPs

Robert produced a list of other articles that propose mechanisms of GPs and your article falls into that list. Your article is no different to them, only most of them have better research methods than yours and have a single hypothesis

WHat is clear is that your article postulates as to the mechanism of growing pains and postulates one way of treating growing pains. Should we be grateful for your meagre contributions?.........hmmm

 

Thanks for the considerate reply. I find it interesting, however, that my discussions with a world reknown Podopediatrician and vasc/thoracic surgeon never revolved around the process by which I came to my hypothesis.

Robert, simply put, made a claim he couldn't/didn't support. Not once have I read from any of the contrarians here that hold him to the same standards you hold my article. Quite interesting indeed. Take the information and discard or test...it's really that simple...and all we're asking. No sales job, no unique proprietary orthotic, no financial gain on my part. Simple, concise and successful. If better patient outcomes is the end point, we should all look carefully at these problems with a renewed, and possibly different, perspective.

 

Yes, I hate my patients and couldn't think of anything worse than helping them...

Sigh. You're right of course.

Matthew, to help you with this chicken/pigeon chess idiom, I present this link;

http://www.urbandictionary.com/define.php?term=Pigeon chess

Hope that helps.

Bel

 

You appear to be the only person who thinks so. Wonder why

I'll get to the rest later. Just finished digging out about 2 tons of topsoil from my front garden. I need a beer and a bath before I'll be human. But I have at least achieved artificial grass in our time.

 

I feel your pain.

 

"Refers to having a pointless debate with somebody utterly ignorant of the subject matter, but standing on a dogmatic position that cannot be moved with any amount of education or logic, but who always proclaims victory."

LOL! It appears that I have forgotten more about this subject than you presently know. It also appears that better patient outcomes ranks down the list in your world. I've never accused you of "hating" your patients. What I have insinuated, however, is your attacks of those here at PA that offer contrarian opinions to yours. I've also merely suggested that you explore the possibility as to the accuracy of my hypothesis is accessing those patients that complain of this very problem, (oh the horrors of that!).

Yes...it most certainly does help. Thanks.

 

Belinda, I demanded a link to explain the chicken / chess idiom. You've given us nothing. There is no chicken chess idiom. Everyone can see that.

 

So why did you like the article, Kevin?

 

Let me know if/when you find an article that suggests why/how orthotics work in treating GP's in children. You haven't accomplished that yet.

http://scholar.google.com/scholar?hl=en&q=growing pains in children&btnG=

Hope this helps.

 

Righto then.

You know the nice thing about forum debates is that one can read back, and call people on what they've already said. And you can see when they attempt to move the goalposts. In fact, I'm not even sure you realised you'd done so.

Drhunt, you said...

Nope. I said

I'm guessing I'm going to have to spell out the difference between the two. Why and how are, you see, very different words.

If the Psychosomatic model was correct, that would explain why orthotics work (because it would impact the psychological situation)

If the anatomical (flat feet) model was correct, that would explain why orthotics work (because it would adjust the kinetics and probably kinematics of the STJ range).

If the bone density model was correct, that would explain why orthotics work (because they might well reduce the bending moments in the tibia by altering the COP)

If the muscle fatigue model was correct, that would explain why orthotics work (because they might reduce the workload in the tibialis Ant / Post by exterting external inversion moments and thus reducing the internal inversion moments required of the muscles.

The point being (worth coming back to after 2 pages) that your "data" does not support any of the hypotheses which you ommitted to state in your paper, but added after the event.

For an encore. You said:-

Which you later changed to

You see what you did there? Asked for one thing, then pouted when I gave it to you, and pretended that you asked for something else. You asked for studies which offer viable explanations for the cause of GPS. Your words. Now you say you want articles which explain why / how orthoses work in treating GPs. Make up your mind!

However. notwithstanding that. Allow me, for the benefit of those following along at home, to quote from one of the studies I referenced. Remembering the brief was...

Oky doky!

And you are STILL sticking to your guns, that this does NOT "suggests why/how orthotics work in treating GP's in children?":wacko:

Really?! I'm impressed by the ferocity of your denial of what is in front of you, but come now.

Still curious about your thoughts on whether insoles cure infertility btw. I'd love to know if you accept poor quality evidence from other people, or if you just everyone else on yours.

 

So...are you going to vilify and disparage the authors of that study? I'm just wondering if you sent them an email that described the problems you have with their definitions and BALD assertions. I mean...myalgia of the peroneal and posterior tibialis muscles should be pretty easy to test, right?

You also wrote: "It's an interesting piece, but at best if forwards a hypothesis."

Bingo! And I offered a method to test that hypothesis for all practitioners to try themselves...and it takes just a second of their time. You also wrote: " It may, indeed, inspire somebody to design a genuine research study to test it." Bingo again! But you still haven't addressed another concern of mine which is Hashkes et all making the BALD assertion that the malady is non-articular without ever providing his reasoning or evidence to demonstrate his contention. Did you contact him as well?

Then you wrote: "Like many podiatrists I've been treating growing pains very successfully for many years, with a combination of orthoses and stretching. As have all the people in my team. As has, I hope, anybody who's been to one of my lectures on Paediatrics. Actually, its one of the easier conditions to treat, in my experience even pre fabs do the job pretty consistently."

Yet you can't describe how they work, nor can you cite studies that prove how they work, (other than the study that suggests myalgia...which was by constant prodding on my part). Yes...pre-fabs work well for mild cases of this dilemma...a point I made in the original manuscript. I really haven't seen/read too much on this in print, however...so I guess that it's just conjecture on your part? Through what mechanism...your own experience? Bingo, once again!

Full circle, eh?

 

Been on holidays good to see things have changed in the last 2 weeks


Good Times




For those bored and want to tap their feet for 3 min catching little number imho

 

Oh have we moved the goalposts again? I believe we have. Not 3 posts back, you were saying

And now its

(emphasis mine).

Kinda sucks for you that everyone gets to see you doing that huh.

And which I posted half way down page 3, but which at the time you did not realise that they had suggested an aetiology. I'm guessing you didn't read to the bit where they suggested myalgia.

Everyone saw you do that too.

Nope.
First of all, I didn't send YOU an email describing the problems in your study. You rocked up in here asking what people thought of it.

But that's incidental. The main reason I would not critique their study so harshly is that their study is better. Their HYPOTHESIS (not claim) was that

Their test was to use orthoses and monitor outcomes.

And their conclusion was

Can you see the difference between that and your study? A clear hypothesis, which was stated as a hypothesis rather than a fact, a clear, repeatable methodology, a clearly described method of data collection, a statistical analyses and a conclusion which is related to the hypothesis and supported by the data. Not one of those things can be said of your parallel work.

Not to say that there are not things I dislike in that study, but it is basically sound.

Oh now you agree with that? Only in the article, and since, you were not merely forwarding a hypothesis, you had found the answer.

Awww, cute. You think its about the authors of the study:empathy:? No. My critique is entirely with your body:deadhorsef work. Whilst I have developed a fair dislike for you in the meantime, for a variety of reasons, not least the disingenuous way you ignore arguments you don't like, and consistently attempt to shift the goalposts of the discussion, I would remind you that the criticisms I made of your study came before all that. Out of interest why do you think you are alone on this thread arguing that your work has any merit whatsoever?

 

Jesus wept. Fine, fine, cite the study and the bit of it you want me to address and I'll have a look. Make it specific, please, you seem to retroactively change your mind about what you're asking fairly often. If you're that interested in my views, you'll want to make sure I address the point you want addressed.

Quid pro quo, I'll do that if you tell me if
A: you find Brian Rothbarts "research" convincing
and
B: if not, why not.

 

Quid pro quo? LMBO! How very British of you to cherry-pick my questions and change the goalposts. First, I don't abide by reflexology...never have embraced the concept. Second...since you've admitted that you've given lectures on GP's, have treated it successfully for years and find the malady quite simple...tell this board YOUR theory on what GP's actually are. What are you telling YOUR patients and students as to the cause?

Hashkes has made this claim several times in his papers...I'm surprised you haven't read them...considering you're a self proclaimed expert on the topic. Here is but one from 2008:

http://www.ccmcresidents.com/wp-content/uploads/2011/07/Growing-pains.pdf

And another from 2007:

http://www.ped-rheum.com/content/5/1/5

Hashkes makes the statement that GP's are non-articular, but never divulges how he arrived at that conclusion. At least in my article I forwarded a method to test my hypothesis, gave multiple anecdotal treatment successes, (over twice as many as Angela Evans offered in 2003), and formulated a plan as to how to proceed to test my hypothesis...something you acknowledged as being valuable.

We'll start there...and let's see if this goes anywhere.

 

The study you referenced was published in April 2015...the same month mine was published.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414976/

So previous to that study...what else did you come up with that possibly describes the manner by which orthotics function to treat GP's? And considering, again, that you stated you've lectured on this subject numerous times, prior to reading my article and/or the one you referenced...what were you telling your students as to the cause? WHAT WERE YOU TELLING YOUR PATIENTS?

I guess after spending over a week of back and forth, the debate is winding down...isn't it?

"Whilst I have developed a fair dislike for you in the meantime, for a variety of reasons, not least the disingenuous way you ignore arguments you don't like...".

Right back at you...except, of course, the gotcha question in re to reflexology. Changing the goalposts once again? Tsk, tsk.

 

And I know Dr. Phillip's pain as well.